Provider Demographics
NPI:1457694986
Name:MIDWEST CITY HMA PHYSICIAN MANAGEMENT LLC
Entity Type:Organization
Organization Name:MIDWEST CITY HMA PHYSICIAN MANAGEMENT LLC
Other - Org Name:SHAWNEE SPECIALTY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:EASTERLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-598-3131
Mailing Address - Street 1:5811 PELICAN BAY BLVD
Mailing Address - Street 2:SUITE 500
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-2733
Mailing Address - Country:US
Mailing Address - Phone:239-598-3131
Mailing Address - Fax:239-592-0438
Practice Address - Street 1:3700 N KICKAPOO AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1707
Practice Address - Country:US
Practice Address - Phone:405-273-6383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HEALTH MANAGEMENT ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-03
Last Update Date:2013-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK600522383Medicare PIN